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Sans prétendre être une recherche exhaustive sur le travail enseignant, cet article vise à mettre en évidence la part des prescriptions et des savoirs formels dans le modèle d’enseignement pratiqué dans le premier degré en Tunisie. Décrire le travail enseignant tel qu’il se fait et chercher à expliquer pourquoi il se fait comme il se fait, est l’objectif principal de cet article. C’est un article qui entend mettre en lumière les caractéristiques d’un modèle d’enseignement plaçant encore la focale sur la transmission de savoirs et l’évaluation dans toutes ses dimensions classiques. Abstract Without claiming to be an exhaustive research on teaching work, this article aims to highlight the role of pescription and formal knowledge in the teaching model practiced in primary education in Tunisia. Describing the teaching work as it is done and seeking to explain why it is done as it is, is the main objective of this article. It is an article that intends to shed light on the characteristics of a teaching model that still focuses on the transmission of knowledge and assessment in all its traditional dimensions.

Background: Oxycodone entered the market in Germany in 1998 as an oral opioid analgesic, after it had been withdrawn from the market in 1990. Today it is the most prescribed oralWorld Health Organization (WHO) level 3 opioid, although its analgesic effect is no different from that of other opioid analgesics. In 2017, it was prescribed more often than ibuprofen in Germany. Objectives: What is the explanation for this rise? Methods: Scoping literature review, evaluation of pharmaceutical statistics and guidelines, discussion of recommendations. Results: The rise of oxycodone prescriptions is not due to its pharmacological or medicinal properties. The causes of its frequent prescription are the marketing efforts of a pharmaceutical company. Medical sources of information have been influenced or changed on a large scale. Conclusions: The rise in the popularity of prescribing oxycodone was possible because physicians have paid too little attention to the quality of sources providing pharmacological information. [ABSTRACT FROM AUTHOR]

Background: There are previously published data on the per capita use of analgesics in Germany, but only to 2005. In the present analysis, data for the years 2008-2019 were evaluated. The use of prescription and nonprescription analgesics was investigated and possible influencing factors were discussed., Materials and Methods: The per capita use of prescription and nonprescription analgesics was determined based on data on prescriptions and cash purchases in pharmacies (IMS Pharmascope®, Wiener Neudorf, Austria). Moreover, an evaluation according to active substances was performed for nonprescription drugs. In addition, pharmaceutical manufacturers' advertising expenditures and changes in distribution channels were analyzed as possible influencing factors., Results: During the observation period 2008-2019, the use of prescription analgesics in Germany increased, while the use of nonprescription analgesics decreased. Single-agent drugs constitute the majority of sales of nonprescription analgesics. The share of combination drugs has decreased in recent years., Conclusion: The use of nonprescription analgesics in Germany decreased between 2008 and 2019. The trend as of 1995, which was observed in a previous investigation, is therefore continuing. External factors, such as the increase in advertising expenses or easier access via mail-order pharmacies, do not appear to influence use., (© 2022. The Author(s).)

Introduction: This article illustrates the procedures of the prescription model which came into force on July 1, 2022. The prescription model allows psychological psychotherapists to treat and bill patients referred to them by a physician as independent service providers via mandatory health insurance. The article describes the treatment process under the new model. It also points out the challenges when implementing the new model and identifies potential for better interprofessional collaboration between the prescribing doctor and the psychological psychotherapist in the treatment of their shared patients., Competing Interests: Es bestehen keine Interessenskonflikte., (© 2023 Aerzteverlag medinfo AG.)

Social participation in nursing homes with Covid-19 protection measures in the second pandemic wave? Linkage of prescriptions and survey Abstract: Background: The implementation of protective measures in nursing homes during the Covid-19 pandemic was accompanied with the loss of social participation opportunities in the first Covid-19 wave; this has been inadequately studied for the second Covid wave. Aim: To evaluate the association of protective measures and social participation restrictions for the second Covid-19 wave to develop recommendations for action. Methods: Mixed-methods online surve y of nursing home managers ( n = 873) in the second wave. Binary logistic generalized estimating equations were used to evaluate the likelihood of the elimination of social participation services in nursing homes as a function of legal protections. Open-ended responses about maintaining social participation were content analyzed ( n = 1042). Results: More than one in two nursing home managers reported prohibited group events (66,6%), and more than one in three prohibited creative activities (42,3%). Visitation restrictions (85,2%) were common in the second wave. The loss of participation services and the protective measures were significantly associated. Qualitative data showed that, for example, the acquisition of mobile shopping stores were opportunities to counteract the social exclusion of the residents. Discussion: The association between the loss of social participation services with the implementation of protective measures was clearly pronounced. Nursing practitioners should focus on enabling social participation whilst guaranteeing protection against infection best possible.

Aim of the Study: Since 2011, non-vitamin-K-dependent oral anticoagulants (NOAC) have extended the spectrum of anticoagulation therapy. Initially, the approval of NOAC was limited to the prophylaxis of postoperative thrombosis, but in the course of time the spectrum was extended to the therapy of thrombosis and embolism as well as anticoagulation in non-valvular atrial fibrillation. The study was designed to examine how the approval of NOAC had affected the prescribing behaviour of general practitioners in the first years of their approval., Methods: In a retrospective longitudinal study, the prescriptions of anticoagulants between 2012 and 2017 were analysed in 3 general practitioners' practices in the Bonn area. The study included all patients for whom at least one prescription from a NOAC or a vitamin K antagonist (VKA) was documented in the administrative system of the practices during this period., Results: A total of n=579 patient files were evaluated (47% female; median age 75 years). Of these, 47% received a VKA, and 40% a NOAC (59% rivaroxaban, 29% apixaban, 9% dabigatran and 3% edoxaban). During the period under examination, the share of VKA prescriptions decreased from 45% to 14% and the share of NOAC increased from 28% to 87%. Anti-coagulation was changed in 12%. The most frequent change was from a VKA to a NOAC (70%)., Conclusion: After marketing approval, the use of NOAC in the initial prescriptions increased steadily. This trend can also be seen in other European studies. VKA are mainly prescribed to patients with stable oral anticoagulation. As recommended in the guidelines, anticoagulation is changed mainly when problems occur during therapy. If the trend in the prescription of anticoagulants continues, in the medium term, VKA will only be prescribed for patients who have been stable for many years and for patients with artificial heart valves., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

In 2020, prescription-based digital interventions were introduced in Germany. These digital courses have to meet safety and data privacy requirements and must prove positive effects on symptoms and/or other outcome parameters. Interventions are available for a range of mental disorders. For patients with panic disorder and agoraphobia, several applications based on cognitive behavioral therapy have been developed. Within these digital courses, patients can typically access psychoeducational content and practice psychotherapeutic strategies such as exposure therapy. Recent meta-analyses prove the effectiveness of such interventions when compared with waitlist control conditions. According to current German guidelines, digital courses can be used to prepare psychotherapy and as an accompanying tool during psychotherapy. In Germany, physicians and psychotherapist can prescribe digital interventions for outpatients and as a post-hospital treatment.., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Introduction: The use of antibiotics in human medicine is partly responsible for the global increase in antibiotic resistance. Significant reductions in antibiotic prescribing were realised through educational campaigns, communication training and prescribing feedback. Based on data from the cluster-randomised CHANGE-3 trial, the present analysis focuses on the question of patient expectations for an antibiotic in acute respiratory infections., Methods: 106 of 114 General Practitioner (GP) practices in Baden-Württemberg and Mecklenburg-Western Pomerania took part in the study. 4736 patients who visited the practices with acute respiratory infections from October 2018 to May 2019 filled out a questionnaire after the doctor's consultation. The analysis was descriptive., Results: 16.7 % of patients with acute respiratory infections reported receiving antibiotics from their GP. 13.3 % of patients had hoped for an antibiotic and 5.5 % stated that they had asked their GP for an antibiotic prescription. The lowest prescription rate for antibiotics was reported by patients who had received a diagnosis of influenza from their GP. With specific diagnoses differentiated from uncomplicated respiratory tract infection, an increase in both the number of antibiotics hoped for and the number of antibiotics prescribed was observed., Discussion: Patients still receive antibiotics more often than they actually hope for. On the part of GPs, prescriptions may still be written because of perceived pressure from patients, but this is not reflected in patient expectations. In addition to dealing openly with patients' expectations, strengthening patients' health literacy, mindful doctor-patient communication and offered opportunities for re-presentation in the case of specific diagnoses could further reduce the perceived pressure on GPs., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Aerobic endurance training is a core component of exercise training (ET) during cardiac rehabilitation (CR). Improvements of cardiopulmonary performance and symptom-free exercise capacity that can be achieved by ET during CR are essential for patient's prognosis and quality of life. Before initiating exercise training in CR, a detailed risk stratification including incremental exercise testing is required in order to ensure safe and effective exercise training conditions. Cardiopulmonary exercise testing (CPX) with measurement of respiratory gases is considered the gold standard of cardiopulmonary performance diagnostics. The oxygen uptake measured at the highest exercise intensity achieved (peakVO 2 ) has strong prognostic implications in primary and secondary prevention of cardiovascular diseases, respectively. The use of CPX with measurement of peakVO 2 and determination of ventilatory thresholds (VT) enables a reliable determination of the individual cardiopulmonary performance (peakVO 2 ) and also the aerobic exercise capacity. In addition, CPX is a valuable tool to detect increments in exercise capacity that were achieved by ET during CR. The measurement of peakVO 2 and the determination of ventilatory thresholds are basic parameters for an individually tailored exercise prescription. In addition, the targeted control of aerobic endurance training on the basis of CPX parameters increases the effectiveness and safety of the exercise program during CR. In this article, recommendations for an individual exercise prescription, based on the results of CPX, are given for patients with coronary heart disease (CHD), heart failure, as well as for patients with CHD and concomitant type 2 diabetes mellitus., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

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Background: This study aimed at evaluating the use of hypnotics and other psychotropics for sleep disturbances in nursing home residents. Patients and methods: Data obtained from the Resident Assessment Instrument (2.0) were linked to health insurance medication claims data. This secondary analysis was based on data of 2109 residents captured in 37 nursing homes in 2008. Results: According to nurses' rating, 9.8 % of residents had difficulties in initiating or maintaining sleep on a daily or almost daily basis (6-7 days/week), a further 23.5 % on 1-5 days/week. In all, 16.7 % of the residents were treated with hypnotics (of which 3.9 % with benzodiazepines and 3.4 % with Z-drugs), and 47.4 % of the residents received antipsychotics. Prescribing of hypnotics (p < 0.001), antipsychotics (p < 0.001), and anxiolytics (p < 0.001) was significantly associated with sleep disturbances in residents, but not of antidepressants (p = 0.903). Conclusion: Although sleep disturbances were very common among the observed residents, traditional hypnotics were used only moderately. However, high prescription rates of antipsychotics must be evaluated critically. [ABSTRACT FROM AUTHOR]

Specialized outpatient palliative care (SAPV) was introduced by the legislature in 2007 in § 37b of the German Social Code Book V (SGBV) as a form of care for people with a life-limiting illness and an increased complexity of care. It is therefore only required by some of the palliative patients. It is intended to avoid unnecessary hospital admissions and to enable those affected to remain in their home environment in a dignified manner despite a complex illness and to be accompanied there until death. Initially introduced as a form of care for adults, the need for expansion to children and adolescents with life-limiting illnesses soon became apparent, so that care was supplemented in 2011 with specialized pediatric palliative care (SAPPV). Both SAPV and SAPPV involve the use of a specialized and multiprofessional palliative care team (PCT), which is characterized by 24‑h accessibility and special qualifications, thus providing comprehensive support. This is provided in addition to general outpatient palliative care (AAPV) and aims to maintain, promote and, if possible, improve the quality of life and self-determination at the end of life as much as possible. The SAPV is a health insurance benefit and requires a prescription via form 63 by a physician., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Introduction: The use of antibiotics in human medicine is partly responsible for the global increase in antibiotic resistance. Significant reductions in antibiotic prescribing were realised through educational campaigns, communication training and prescribing feedback. Based on data from the cluster-randomised CHANGE-3 trial, the present analysis focuses on the question of patient expectations for an antibiotic in acute respiratory infections., Methods: 106 of 114 General Practitioner (GP) practices in Baden-Württemberg and Mecklenburg-Western Pomerania took part in the study. 4736 patients who visited the practices with acute respiratory infections from October 2018 to May 2019 filled out a questionnaire after the doctor's consultation. The analysis was descriptive., Results: 16.7 % of patients with acute respiratory infections reported receiving antibiotics from their GP. 13.3 % of patients had hoped for an antibiotic and 5.5 % stated that they had asked their GP for an antibiotic prescription. The lowest prescription rate for antibiotics was reported by patients who had received a diagnosis of influenza from their GP. With specific diagnoses differentiated from uncomplicated respiratory tract infection, an increase in both the number of antibiotics hoped for and the number of antibiotics prescribed was observed., Discussion: Patients still receive antibiotics more often than they actually hope for. On the part of GPs, prescriptions may still be written because of perceived pressure from patients, but this is not reflected in patient expectations. In addition to dealing openly with patients' expectations, strengthening patients' health literacy, mindful doctor-patient communication and offered opportunities for re-presentation in the case of specific diagnoses could further reduce the perceived pressure on GPs., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

It is a widespread assumption that gender specific drug therapies only emerged at the end of the last century, but prescription manuals of the 18th and 19th centuries, some also of the early 20th century, prove this assumption to be wrong. Gender considerations did, in fact, play a part in the dosage of drugs since standardized prescription charts stipulated that dosages for women should be one third to one fifth lower than those for men. 18th century prescription books show moreover that more prescriptions were issued for men than for women. The specific anthropology of women developed in the latter half of the 18th century that portrayed women as weak and sickly did not result in more women than men consulting academically qualified physicians and receiving prescriptions. The prescription practice as presented in this pilot study thus differs significantly from the situation today. It was not due to “anthropological constants” or even “genetic behaviour coding” but above all to the habits of physicians and related financing models.

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Background: Since the approval of the digital care law (Digitale-Versorgung-Gesetz-DVG) on 19.12.2019, physicians have been able to prescribe digital health applications (DHA). Patients are now entitled to such applications. The present article sets out to clarify how physicians should integrate DHAs into patient care and the ethical responsibilities they have in this process., Methods: Based on an adapted principle-oriented case analysis, three hypothetical case scenarios are discussed. The argumentative-analytical approach is based on four established principles of medical ethics (following Beauchamp and Childress), namely autonomy, beneficence, non-maleficence and justice, as well as on the Model Professional Code of Conduct for Physicians working in Germany (MBO-Ä)., Results: When prescribing DHAs, physicians need to give patients additional information on the specific risks that result from such applications. Special attention must be paid to patients' digital health literacy. Furthermore, DHAs should not replace personal contact, but complement and support guideline-based treatment. To enable patients to use DHAs more independently, we recommend an 'app anamnesis'., Conclusion: Beauchamp's and Childress's principles as well as the MBO-Ä are instructive for handling DHAs in patient care. The Dos and Don'ts presented must be complemented by further guidance providing orientation for physicians on how to integrate DHAs in patient care in a responsible way., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Covid-19 protections and social life limitations in nursing homes - Analysis of prescriptions and survey data Abstract. Background: The tension between health protection and restrictions of social life in nursing homes during the pandemic has been little addressed. Aim: The aim of the study was to systematize state-specific regulations and actual prioritizations as well as implementations of the pandemic measures and to relate them to life changes for residents. Methods: The prescriptions were categorized into five themes. Primary data show that "visitation bans" (98.3 %) and "physical contact reduction" (90.5 %) represented the largest proportion of restrictions. The regulations were variously associated with the "restriction of social services". Thus, across all offers prohibitions and for most offers "contact reductions" were significantly associated, for example that giving up "group opportunities" was almost two times as high when the protective measure "reduction of physical contact" was implemented. "Visit restrictions" on the other hand showed little significant association. Results: The prescriptions were categorized into five themes. Primary data show that "visitation bans" (98.3 %) and "physical contact reduction" (90.5 %) represented the largest proportion of restrictions. The regulations were variously associated with the "restriction of social services". Thus, across all offers prohibitions and for most offers "contact reductions" were significantly associated, for example that giving up "group opportunities" was almost two times as high when the protective measure "reduction of physical contact" was implemented. "Visit restrictions" on the other hand showed little significant association. Conclusions: The results provide evidence of an association between protective measures and social restrictions in the care homes during the pandemic. However, as these lost exchanges are of high value for the residents, aversive long-term effects must be assumed.

Objective: To investigate the frequency of outpatient physical therapy (PT) in persons with rheumatoid arthritis (RA), axial spondylarthritis (axSpA), psoriatic arthritis (PsA) or systemic lupus erythematosus (SLE) between 2005 and 2020., Methods: Adult insured persons of the BARMER health insurance fund with a diagnosis of RA (ICD-10: M05, M06), axSpA (M45), PsA (M07.0-3) or SLE (M32.1,8,9) were included. The prescription of PT was identified via the national item number index for therapeutic products. The proportion of persons with at least 1 prescription in the years 2005 to 2020 is reported as well as PT prescriptions by age and gender groups. In addition, the number and duration of prescriptions were compared and it was analyzed whether persons in specialist care received PT more frequently., Results: In 2020, 43% (SLE), 46% (RA, PsA) and 49% (axSpA) received at least 1 PT prescription. Physiotherapy was prescribed most frequently (37%), followed by manual therapy (14%) and thermotherapy (10%). Since 2005 the number of insured persons receiving PT has not changed. Manual therapy is increasingly prescribed (+7%), while massage (-10%), thermotherapy (-7%) and electrotherapy (3% in 2005, 2% in 2020) have been decreasing (data relating to RA). The number of prescriptions has not relevantly changed since 2010. Persons in orthopedic care received PT more frequently than persons in general or rheumatological care. Female patients 61-80 years old were most frequently treated with PT., Conclusion: Slightly less than half of all persons with an RA, axSpA, PsA or SLE diagnosis received outpatient PT. This proportion has hardly changed in the last 15 years., (© 2022. The Author(s).)

The article examines the history of gender specific drug therapies in the 18th century, drawing from prescriptions books and charts which show prescription practices for men, women, and children of that time. The charts coming from German medical doctors Hieronymus David Gaub and Christoph Wilhelm Hufeland show that gender considerations did play a factor in drug dosages, that more prescriptions were issued for men than for women, and that the age of a person also played a role. Also referred to is medical professor Ernst Harnack, a scientist who believed that medicines given to a pregnant woman might harm the fetus.

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Hintergrund: Akute Atemwegsinfektionen gehören zu den häufigsten Ursachen für einen Arztbesuch. Die vorliegende Arbeit untersucht die Behandlung akuter Atemwegsinfekte durch anthroposophisch orientierte Ärzte unter besonderer Berücksichtigung von Antibiotikaverordnungen, Komplikations- und Rezidivraten sowie Rezeptkosten. Material und Methoden: In einem Netzwerk von 35 Hausärzten in Deutschland wurden alle Verordnungsdaten beginnend ab Mai 2004 über den Zeitraum eines Jahres erfasst. Dazu wurden regelmäßig ärztliche Routinedaten durch speziell entwickelte Schnittstellen aus Praxissystemen ausgelesen. In standardisierten Web-Interfaces nahmen die Ärzte ergänzend eine Verknüpfung von Medikamenten und Diagnosen vor. Ergebnisse: Es wurden 21 818 Verordnungen von 12 081 Patienten (73,7% Kinder) für 19 050 akute Infekte der oberen Atemwege ausgewertet. Die häufigsten Diagnosen waren grippale Infekte (63,3%) und akute Tonsillitiden (12,9%). 63,0% der Erkrankungen wurden rein komplementärmedizinisch behandelt. Antibiotika wurden in 6,3% der Fälle verordnet (Minimum: grippale Infekte: 1,9%, Maximum: Tonsillitis: 24,3%). Prädiktive Faktoren für den Antibiotikaeinsatz waren neben den Diagnosen Tonsillitis (Odds Ratio [OR]: 6,7; 95%-Konfidenzintervall [KI]: 4,5-9,9) und Sinusitis (OR: 1,9; 95%-KI: 1,1-3,1) Begleiterkrankungen (OR: 1,2; 95%-KI: 1,0-1,4), Komplikationen (OR: 7,2; 95%-KI: 5,5-9,4) und die Facharztausrichtung Pädiatrie (OR: 2,1; 95%-KI: 1,7-2,6). Die Nachverschreibungsrate von Antibiotika für zunächst rein komplementärmedizinisch behandelte Patienten war mit 0,7% gering, ebenso die Komplikationsrate (2,9%) und die Folgekonsultationsrate (6,3%). Durchschnittlich erkrankten die Patienten 2,4-mal pro Jahr an einer akuten Atemwegsinfektion (Erwachsene: 1,7; Kinder: 2,7). Die Medikamentenkosten von komplementärmedizinischen und Antibiotikarezepten unterschieden sich nicht. Schlussfolgerung: Durch Aufbereitung und Ergänzung ärztlicher Routinedaten konnte der Verschreibungsalltag anthroposophischer Hausärzte abgebildet werden. Bezüglich des Einsatzes von Antibiotika wurde eine spezifische leitlinienkonforme Therapie durchgeführt. Die Antibiotikaverschreibungsrate lag deutlich unter dem Bundesdurchschnitt. [ABSTRACT FROM AUTHOR]

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